Time to set safe sex straight! (COMING OUT OF THE CLOSET, 2011)

Jan 18, 2011

Dear Dr Bob, I am so thankful you are here but its time to set people like me straight! I have just had oral sex with an unknown individual at a bathhouse.
I have had similar scares before but very lucky! Why I keep putting myself through this stress is beyond me!!(closeted gay)..... That's why... After every sexual encounter I think I have been infected because I am gay. I swear never to do it again Every year or so later I goof up! I hear something is called safe sex,... try it ..I find out later it is not-so safe .I just again gave and received a blow job thinking it was safe with .... no ejaculation.... just a few minutes!!! Now go to the internet. Some say it's safe some say not! I now have to go through another 6 months of hell!Why don't you say oral sex is not safe!!!!!Because if it was I wouldn't be so worried.Stop the madness!

Response from Dr. Frascino

Hi,

Why don't we just say oral sex is not safe??? Good question. Actually, that is what I have been saying for years but with appropriate qualifying statements regarding the degree of risk involved. See the chapter devoted to oral sex in the archives of this forum. Oral sex, while not 100% safe, is for some folks "safe enough." Every individual needs to decide what level of risk they are willing to take. An analogy might be walking in a thunder-and-lightening rainstorm, carrying an umbrella. We could say it's not safe, because there is a possibility you could get zapped to smithereens by a lightening bolt. However, most folks are willing to accept that level of extremely low risk and still carry their umbrella.

Regarding the HIV risk associated with unprotected oral sex, see below. There is also, as I mentioned above, much more information in the archives of this forum where we have chapters devoted to oral sex, safer sexual practices, HIV sexual prevention, etc.

In closing, I must also advise it's definitely not in my power to "set people like (you) straight"!! After all, you are gay, right? As for being a "closeted gay," I would just repeat your final sentence: "Stop the madness!" I urge you to come out. Closets are health hazards! See below for some coming out stories from the archives.

Dr. Bob

oral sex (TRANSMISSION VIA ORAL SEX, 2011) Jan 14, 2011

my boyfriend is HIV positive and I am not, he tells me that because of his undetectable status having oral sex will not affect me. I need to know if this is so

Response from Dr. Frascino

Hello,

Unprotected receptive oral sex with a poz partner carries a low risk for acquiring HIV. If the poz partner is taking effective combination antiretroviral therapy, which has driven the HIV plasma viral load to undetectable levels, the risk of HIV transmissions is significantly decreased, but not completely eliminated. See below. Only you can decide what level of risk you are willing to accept.

I have been tested at 3 months, 6 months and a year all negative. I was told that I should test up until six months from a possible exposure. The year test was the start of yearly testing I want to begin as part of my routine exams. I also tested at a year becasue there appears to be a lot of mix messages out there on testing,,,some say the window period is 3 month, some say 6 month and some even say that there have been cases where individuals have tested positive after a year. What is the truth? Also, at my year test, I was told by the test counselor that there in no evidence that performing oral sex transmits hiv. That they only say that oral sex is a low risk becasue they operate and are funded by the CDC. Is this true??? Confused.

Response from Dr. Frascino

Hi Confused,

Yes, there are many mixed messages out there regarding the HIV test window. Guidelines in parts of Australia advise that a six weeks test is conclusive. Other older guidelines claim six months are necessary for a definitive result. In the U.S. the CDC recommends three months, unless there are extenuating circumstances, such as a significant occupational exposure in a health care worker or a significant exposure with a partner confirmed to be HIV positive (such as anal receptive sex with a partner confirmed to be HIV positive). For these cases testing out to six months is warranted, according to the CDC's guidelines. Part of the reason for the confusion is that the testing window has been shortened in some guidelines as HIV-testing procedures have become more sophisticated and as we have learned more about the natural history of HIV and the body's immune response to infection. You can read much more about this controversy and conundrum in the archives of this forum.

Regarding the HIV transmission/acquisition risk of oral sex, I do not agree with the information given by the counselor. See below.

Dr. Bob

Please post this (TRANSMISSION VIA ORAL SEX, 2010) Sep 15, 2010

because it is rarely asked (actually often asked but rarely posted). I gave a BJ and got cum in my mouth (all other posts claim no cum in mouth). No straight guy question about lap dances, but a real risk. What are my risks of HIV?

Response from Dr. Frascino

Hi,

Actually it's been asked and answered numerous times. We have an entire chapter devoted to oral sex in the archives. Check it out!

The CDC's estimated per-act statistical risk for acquiring HIV from unprotected receptive oral sex (including getting a mouthful of high-protein baby-batter) with a partner confirmed to be HIV positive is 1 per 10,000 exposures. Also see below.

Dr. Bob

Oral Sex: What's the Real Risk? July 2010

The chances of HIV being transmitted from an HIV+ person to an HIV-negative person depends on the type of contact. HIV is most easily transmitted through unprotected (no condoms) anal sex, unprotected vaginal sex, and sharing injection drug equipment.

Oral sex has been shown to be less risky than these activities, but it is not risk-free. It is also possible to get other sexually-transmitted diseases (STDs), such as syphilis, herpes, and gonorrhea through oral sex.

Studies on the Risks of Oral Sex

Even though oral sex is a lower-risk activity, people have reportedly become infected with HIV in this way. A number of studies have tried to determine the exact level of risk of oral sex, but it can be difficult to get accurate information from study participants. Since oral sex is not the only sexual activity for most people, it is also difficult to single out oral sex as the definite way HIV was transmitted. Because of these issues, different studies have reported different levels of risk ranging from less than 1% to about 8%.

The take home message of these studies is that oral sex carries a small but real risk.

Tips for Safer Oral Sex

Oral sex is more risky if you or your partner have an untreated STD, bad oral hygiene (bleeding gums, ulcers, gum disease), or take ejaculate (cum) in the mouth. There are things you can do to reduce the risk associated with oral sex:

Don't have oral sex if you or your partner have mouth sores (such as oral herpes lesions). Look at your partner's genitals for lesions (cuts or scrapes). If you find something, don't believe your partner if he or she tells you it was caused by the heat, the weather, or clothes. You should avoid any contact with the area until a health care worker has examined it. Don't floss, brush your teeth, or do anything that would create abrasions or cuts in your mouth before performing oral sex. Use mouthwash or a breath mint instead. Avoid swallowing pre-cum, semen, or vaginal fluids. Use latex condoms for oral sex on a man (try the unlubricated, flavored ones). If you perform oral sex without a condom, finish up with your hand, or spit semen out and rinse with a mouthwash rather than swallowing. Use a dental dam or cut-open condom for oral sex on a woman or for rimming (licking the anus). Dental dams are squares made from latex. Put some water-based lube on one side of the dental dam or a condom that has been cut open. Then stretch the dam or condom over the vagina or anus with the lubed side facing down. This gives you a thin barrier between your mouth and the vagina or anus. (Some people use plastic food wrap as a barrier. While plastic wrap has been shown to prevent the transmission of herpes infections, there is no proof that it will prevent the transmission of HIV.) Avoid vaginal oral sex during menstruation to prevent contact with blood. Take care of your mouth. The likelihood of oral HIV transmission increases if you have bleeding gums, ulcers, cuts, sores, or infections in the mouth. Find alternatives Try massage or mutual masturbation. Use a vibrator (use a condom when sharing). Avoid vigorous, prolonged oral sex ("deep-throating"). Avoid mouth or throat trauma caused by a large number of partners in a short period of time.

Taking Care of Yourself

Any type of sexual activity with an infected person carries a risk of HIV transmission. While the risk of becoming infected through unprotected oral sex is lower than that of unprotected anal or vaginal sex, bad oral hygiene and taking cum in your mouth makes oral sex more risky.

If you or your partner is HIV+, you should decide what steps to take to make all types of sex as safe as possible. If you would like to discuss these issues, see a sex educator or health care provider at your local AIDS service organization or treatment center.

I am an Emergency Room doctor, last week I had someone asked me wither being the insertive partner of oral sex (getting sucked) is a risk for HIV, I said no. Some of my colleagues said yes, we decided to debate this out like academics (I can imagine you laughing and shaking your head at the screen right now). After some reading, I think the mixed opinion among doctors is pretty much same in the field of GU medicine.

How I see it, theoretical risk is possible, but after 25-30 years of HIV endemic (billions of blow jobs later) and no clear documented report of receptive to insertive oral sex HIV transmission, can't we just come to the consensus that there is no risk from insertive oral sex? When we tell HIV scared people there is a very low risk, they don't really hear the "very low" part they just hear the "risk" part, hence the mountains of questions and anxiety about oral sex.

One can imagine a lot of day to day scenarios as a "theoretical risk": what if I go to a bar, the barmen cut his finger served me a drink and I drank it immediately? What if someone has bleeding gum and his spit came into contact with my eye when he sneezed near me. Has anyone thought to caught HIV that way? No. . . . . I think we get the picture here right?

So whats the difference when the scenario is getting your willy sucked and HIV risk? Remember earlier in the epidemic people were worried about mosquito bites and HIV transmission? theoretically possible? Yes. Ever documented to have happened? No. and yet we confidently advice people that it is not a risk for HIV. Just like the hundreds of worried mums who bring their kids into the ER after their children got stuck with hypodermic needles found on the beach, any of them got HIV? Not that I have heard of.

Understandably, it is a difficult thing to study, I can see so many confounding factors reading a few papers out there on the subject, but from most of discordant couple data we got, if they used condom consistently for virginal or anal sex the HIV -ve partner stays HIV -ve. I wonder if they always used condom for oral sex, I think unlikely.

You have more experience then most experts in the field, I will be interested to hear your thoughts on the subject, if I am wrong then there is a learning point for me from a well respected World expert!

Many Thanks

Kelvin M.D

Response from Dr. Frascino

Hi Kelvin,

While I agree there is room for debate, I do not personally believe we can "just come to the consensus that there is no risk from insertive oral sex." See below. However, there is indeed consensus regarding some of your other scenarios: the barman with a cut on his finger, mosquitos, etc. These are indeed absolute no-risk situations.

hi! just want to ask you a very quick question, Dr Hansfield at Medhelp says insertive oral is essentially zero risk, but you say is NOT non-existent. . . . . it it because you know someone who got HIV that way? From what I have read there hasn't been a documented case. . . . is confusing for us lay people when experts don't give us the same answer :(

Would you recommend testing if insertive oral sex is the only exposure for medical rather then anxiety calming reason?

p.s. have you got any recording/ video of you playing the piano? I live in the UK can't get to your Concerted Efforts performance, is great to see someone so talented. . . . . . World Expert and a great musician!!!

Be grateful if you could clarify

Worried

Response from Dr. Frascino

Hi Worried,

Actually it's just a question of semantics. "Essentially zero risk" is not the same thing as absolutely no risk. Consequently my comments of "NOT nonexistent" could be consistent with "essentially zero risk."

As for my personal experience, yes, I've had patients who claim to have been infected via insertive oral sex. However, since the sex police weren't there to confirm that insertive oral sex was the only type of sexual contact, I cannot be certain these guys were being completely honest. I'll post some information below from the CDC and other sources supporting my "NOT nonexistent" rationale.

Regarding HIV testing, for guys who generally try to play safe but have unprotected oral sex with multiple partners, I recommend routine HIV-antibody testing every 6 to 12 months.

Regarding a recording/video of my musical exploits, we do have a promotional DVD that explains the genesis and mission of The Robert James Frascino AIDS Foundation, which has short clips from our Concerted Effort events. You can contact the foundation (www.concertedeffort.org) if you would like one. Generally they are sent out as token thank-you gifts for those who make donations to the foundation, but sometimes there are extra copies available on request.

Good luck. Be well.

Dr. Bob

Oral sex Published: 08 April 2010

How risky is oral sex?

When is oral sex more risky?

How can you reduce the risks?

Doctors and researchers aren't quite sure how many people have got HIV from oral sex. Some think hardly anybody has been infected with HIV from oral sex, but other people think that as many as 3% of infections are due to oral sex. In late 2008 researchers looked at all the available evidence and calculated that the risk of contracting HIV from oral sex was very low, but that it wasn't zero.

It is known that oral sex involves less of a risk than unprotected anal sex or unprotected vaginal sex.

How risky is oral sex?

The likelihood that HIV is transmitted from an HIV-positive person to an HIV-negative person depends on the type of contact involved. HIV is most easily transmitted by unprotected anal sex (that is, without condoms), unprotected vaginal sex, sharing injecting equipment, and from mother to baby. It also depends on the viral load of the person with HIV, and the dental health of the person performing oral sex.

Oral sex has been shown to be a less risky activity than these practices, but is definitely not risk free. It's also worth remembering that other sexually transmitted infections, such as syphilis, herpes and gonorrhoea, can be quite easily transmitted through oral sex.

A number of studies have been published on the risks of HIV transmission from oral sex. One American study reported that of 122 gay men with HIV, 8% reported oral sex as their only risk activity. But this study doens't have much credibility. The numbers were very small. Plus some of the men in this study who initially said oral sex was their only risk activity later said they'd had unprotected anal sex.

It's worth noting that a study didn't find any cases of oral transmission of HIV over a ten year period in over 100 couples where one partner was HIV-positive and the other HIV-negative.

Another study from the US found involving gay men found the risk to be effectively zero, but didn't exclude the possibility of there being a risk.

Researchers have looked at all the studies looking at the risk of HIV transmission from oral sex. They found that the risk was very low, but not zero.

When is oral sex more risky?

You are at more risk of passing on HIV through oral sex if you have an untreated sexually transmitted infection. You are at more risk of being infected with HIV from oral sex if you have cuts, sores or abrasions in the mouth or on the gums. There is also more of a risk if you have an infection, including sexually transmitted ones, in the throat or mouth which is causing inflammation.

Having high viral load in the blood may also mean that viral load is high in the semen. Although there is good evidence that men who have an undetectable viral load in their blood usually have an undetectable viral load in their semen, this isn't always the case. Factors like untreated sexually transmitted infections can cause viral load in semen to increase. Therefore most doctors believe that you cannot automatically assume that having an undetectable viral load means you're uninfectious. However, the risk of HIV transmission from oral sex if a person has an undetectable viral load are extremely low.

The levels of HIV in vaginal fluid vary. They are likely to be highest around the time of menstruation (having your period), when HIV-bearing cells shed from the cervix are most likely to be found in vaginal fluid, along with blood. Oral sex will therefore be more risky around the time of menstruation.

How can you reduce the risks?

There are several ways to reduce the risks of oral sex. Naturally, some will be more acceptable than others to different individuals, so you must make your own decisions about the level of risk you find acceptable. If you would like to discuss these issues, ask to see a health advisor, or other health professional, at your treatment centre or genitourinary clinic. Many of the strategies below will also provide protection against other sexually transmitted infections:

You may decide that the risks of oral sex are low enough for you to continue your regular behaviour. You may prefer not to have oral sex because you do not wish to take even a low risk of HIV transmission. You may decide to reduce the number of partners with whom you have oral sex. You may decide to have oral sex with barriers such as condoms for sucking men or 'dental dams' (latex squares) for sucking women. You may decide only to have insertive oral sex (being sucked) as this appears safer than receptive oral sex (sucking). You may decide not to ejaculate into your partner's mouth or not to have someone ejaculate into your mouth. You may decide to avoid oral sex with women during menstrual periods. Look after your mouth. The likelihood of oral HIV transmission increases if one has bleeding gums, ulcers, cuts or sores in the mouth. Don't brush your teeth or floss before oral sex. Take regular sexual health screening. This will identify if you have any sexually transmitted infections, which may increase the likelihood of you transmitting HIV to a negative partner, and reduce the likelihood of you contracting HIV if you are HIV-negative.

What You Should Know about Oral Sex June 2009 (from the CDC)

Oral Sex Is Not Risk Free

Like all sexual activity, oral sex carries some risk of HIV transmission when one partner is known to be infected with HIV, when either partner's HIV status is not known, and/or when one partner is not monogamous or injects drugs. Even though the risk of transmitting HIV through oral sex is much lower than that of anal or vaginal sex, numerous studies have demonstrated that oral sex can result in the transmission of HIV and other sexually transmitted diseases (STDs). Abstaining from oral, anal, and vaginal sex altogether or having sex only with a mutually monogamous, uninfected partner are the only ways that individuals can be completely protected from the sexual transmission of HIV. However, by using condoms or other barriers between the mouth and genitals, individuals can reduce their risk of contracting HIV or another STD through oral sex.

Oral Sex is a Common Practice

Oral sex involves giving or receiving oral stimulation (i.e., sucking or licking) to the penis, the vagina, and/or the anus. Fellatio is the technical term used to describe oral contact with the penis. Cunnilingus is the technical term which describes oral contact with the vagina. Anilingus (sometimes called "rimming") refers to oral-anal contact. Studies indicate that oral sex is commonly practiced by sexually active male-female and same-gender couples of various ages, including adolescents. Although there are only limited national data about how often adolescents engage in oral sex, some data suggest that many adolescents who engage in oral sex do not consider it to be "sex;" therefore they may use oral sex as an option to experience sex while still, in their minds, remaining abstinent. Moreover, many consider oral sex to be a safe or no-risk sexual practice. In a national survey of teens conducted for The Kaiser Family Foundation, 26% of sexually active 15- to 17-year-olds surveyed responded that one "cannot become infected with HIV by having unprotected oral sex," and an additional 15% didn't know whether or not one could become infected in that manner.

Oral Sex and the Risk of HIV Transmission

The risk of HIV transmission from an infected partner through oral sex is much less than the risk of HIV transmission from anal or vaginal sex. Measuring the exact risk of HIV transmission as a result of oral sex is very difficult. Additionally, because most sexually active individuals practice oral sex in addition to other forms of sex, such as vaginal and/or anal sex, when transmission occurs, it is difficult to determine whether or not it occurred as a result of oral sex or other more risky sexual activities. Finally, several co-factors may increase the risk of HIV transmission through oral sex, including: oral ulcers, bleeding gums, genital sores, and the presence of other STDs. What is known is that HIV has been transmitted through fellatio, cunnilingus, and anilingus.

Other STDs Can Also Be Transmitted From Oral Sex

In addition to HIV, other STDs can be transmitted through oral sex with an infected partner. Examples of these STDs include herpes, syphilis, gonorrhea, genital warts (HPV), intestinal parasites (amebiasis), and hepatitis A.

Oral Sex and Reducing the Risk of HIV Transmission

The consequences of HIV infection are life-long. If treatment is not initiated in a timely manner, HIV can be extremely serious and life threatening. However, there are steps you can take to lower the risk of getting HIV from oral sex.

Generally, the use of a physical barrier during oral sex can reduce the risk of transmission of HIV and other STDs. A latex or plastic condom may be used on the penis to reduce the risk of oral-penile transmission. If your partner is a female, a cut-open condom or a dental dam can be used between your mouth and the vagina. Similarly, regardless of the sex of your partner, if your mouth will come in contact with your partner's anus, a cut-open condom or dental dam can be used between your mouth and the anus.

At least one scientific article has suggested that plastic food wrap may be used as a barrier to protect against herpes simplex virus during oral-vaginal or oral-anal sex. However, there are no data regarding the effectiveness of plastic food wrap in decreasing transmission of HIV and other STDs in this manner and it is not manufactured or approved by the FDA for this purpose.

This article was provided by U.S. Centers for Disease Control and Prevention.

I have posted a question before, but now as i have update on the situation i am posting again hoping it will not disturb.

I received a blowjob from a guy who after told me that he was HIV positive. I in the same night a few hours before had protected sex with a condom with a HIV -ve person. I did not notice any lesions, cuts or sores on my penis.

I came into communication with the guy again today who stated that he is on tritherapy and has an undetectable viral load. The guy might be lying just to reassure me and i cannot be certain of what he says.

I am very anxious about this whole situation and would like to know whether i am at risk. I see on various threads that it might be a low risk situation but some others say its a no risk situation. I have also seen on the san fransisco std chart and aids med that receiving oral does not contribute to hiv transmission.

I have taken combivir for 2 days but decided to stop today because i was feeling really bad while taking it. Was that a good idea ?

Thanks for your precious help.

Thanks for your help

Response from Dr. Frascino

Hi,

Unprotected insertive oral sex carries only a very low risk for HIV transmission. See below. If your partner was on effective combination antiretroviral therapy that had driven his HIV plasma viral load to undetectable levels for a considerable period of time, this would significantly decrease the risk of HIV transmission, but not completely eliminate it.

Most HIV physician specialists would not strongly recommend a course PEP for this type of scenario. Some might "offer" it without strongly recommending it if the patient was adamant about taking PEP and thoroughly understood the risks involved in taking HIV medications. I would agree with your decision to stop Combivir. You should get an HIV test at the three-month mark.

Good luck.

Dr. Bob

Straight Question (TRANSMISSION VIA ORAL SEX 2010) Jan 3, 2010

Hi Doctor Bob,

Is it in your view permissible to let a negative partner give you oral sex (without ejaculation) where precum is produced but where the recipient is on HAART and undetectable. If there are no recorded cases of transmission in this way and the risk is only theoretical and miniscule with it, then should anyone really be worried about a condom in this situation. Where is the line. Sometimes I wish there were a universal factsheet provided unanimously by healthworkers saying when and in what situation a condom should be used. Complicated medical articles, conflicting opinions and non-committal responses by professionals just add to the confusion & I think may put people in danger. What are your thoughts.

Thank you

A confused London Boy

Response from Dr. Frascino

Hello Confused London Boy,

Another "straight question" for the gay cyber-sexpert. Unfortunately, there is no straightforward answer! You're looking for a "line" when in reality what exists is more of a "zone." All reasonable HIV experts will agree the risk of oral sex is very low, but not completely nonexistent. There can also be a number of confounding variables, including: (1) concurrent STDs; (2) oral membrane trauma, bleeding gums, gingivitis; (3) differences in HIV plasma viral load and viral strains; etc., etc., etc. London Boy, read through the chapter on oral sex in the archives of this forum. Yes, the whole chapter! It'll give you a better understanding of the risks associated with oral sex. I'll also post below some recent information from the archives.

You strongly say that HIV is not transmitted through oral sex on your other posts. Then y did you not raise any concerns on the below post where the person claims of having caught HIV through oral sex.

http://www.thebody.com/Forums/AIDS/SafeSex/Current/Q205768.html

Response from Dr. Frascino

Hello,

OK, let's set the record straight once again! I have never said, let alone "strongly said," that HIV is not transmitted through oral sex! If you read my comments carefully, you will quickly see that I consistently say that the HIV acquisition/transmission risk from oral sex is very low.

Please see below for a more detailed discussion and review of my very consistent comments on this topic. You should also review the chapter on oral sex in the archives of this forum.

Dr. Bob

HIV from Oral Sex Confirmed!!!!! Dec 25, 2009

Dr. Bob.

I read the post from earlier today from the man that wrote he got HIV from Oral Sex. Will you and the "experts" now retract your assurances that Oral Sex is a low to no risk exposure and take a more strident stance that Oral Sex is a significant risk. I am another example. I believe that I as a man was exposed as a result of receiving oral sex from a man. I haven't been tested yet but the symptoms I have are very indicative of HIV. I wish you would take a sterner stance and warm people of the great dangers of Oral Sex. There are probably hundreds if not thousands of us out here that have contracted HIV from Oral Sex. Your thoughts please.

Response from Dr. Frascino

Hello,

You want me to "warm" people??? How should I do that? Pop them in the microwave?

I'd be delighted to give my thoughts as you request, but I'll warn you in advance you won't like what I have to say.

You ask: "Will you and the 'experts' now retract your assurances that oral sex is a low-risk exposure and take a more strident stance that oral sex is a significant risk?" No, of course not, silly boy! Why would we do that if it is not supported by sound scientific facts? The scientific epidemiological evidence collected over the past quarter century is very consistent. Oral sex carries only a very small risk for HIV transmissions/acquisition. Please note, I never claimed oral sex is a "no risk" activity! That one person wrote in to the forum claiming to have contracted the virus via oral sex does not change the overall HIV risk! Please note the gazillions of others who have written in over the years who had oral sex with HIV-positive partners, but did not contract the virus! Science is science; fact is fact; no matter how freaked out you are about your blowjob incident. I'll reprint below some recent information from the archives.

Next, I must point out you also state: "I am another example. I believe that I as a man was exposed as a result of receiving oral sex from a man. I haven't been tested yet but the symptoms I have are very indicative of HIV." Hmm. That statement speaks volumes! I agree you are indeed "another example." However, not an example of oral sex HIV transmission, but rather another example of someone convinced he is HIV infected based on "symptoms," but who has never been tested. (Others have tested negative multiple times, but still remain convinced they are HIV infected, because of "symptoms." In reality, they are not!)

Your claim that there are "probably hundreds if not thousands of us out here that have contracted HIV from oral sex" is pure lunacy.

Dude, get tested. Then write back. I can just about guarantee your opening line will be: "Dr. Bob, I tested negative!"

What is the true risk from oral sex? After looking at many other forums....some sources say there is low risk, some say no risk, some say that while HIV could transmit in theory, there has never been a recorded case of infection from only receiving oral sex - no other activity involved. Also, can being on RX's increase exposure risk - specifically sertraline, atorvastatin, valsartan hydrochlorothiazide or good old aspirin? 6 days ago a stripper went down on me, unprotected, and I ejaculated in her mouth. Is there a transmission chance of virus entering the penis through the tip (no sores here) and can the meds mentioned here make one more susceptible? No excuse as protection should have been used though alcohol was a definite factor here....and six days without a beverage is feeling pretty good right now. This was the first (and last) time this happened. Immediately I was filled with regret and outright fear. Thinking about the stupid thing has consumed me and I really can;t talk about it with anyone. Did a mail in anti-body test (neg) which I now know was a waste - too early. The first few days after this incident I was a basket case, hard to function, extremely down, convinced I'd ruined the future. Constantly checking for symptoms and only have a slightly stuffy nose, little tweak in the ears. I'm worried that the stuffiness is about to turn to a sore throat as some forums say sore throat can happen right after infection and is a symptom (in days???) other don't. So should I be obsessed with worry here, by the sertraline it's easy to tell I go anxiety ridden pretty easily and can be a hypochondriac or am I overreacting? what is the real risk? Thanks in advance.

Response from Dr. Frascino

Hello,

What is the true risk from oral sex? This is a somewhat difficult question to respond to, as there can be confounding variables. See below for some recent information from the archives. (By the way, we have an entire chapter in the archives devoted to oral sex. Check it out! My opinion that oral sex carries only a low risk for HIV transmission/acquisition hasn't changed.)

The medications you listed do not increase the HIV risk associated with oral sex.

Should you be obsessed with worry? No.

Dr. Bob

Oral sex/Magnetic Couple (TRANSMISSION VIA ORAL SEX) Jun 15, 2009

Dear Robert,

First of all, thank you very much for providing such great advice and information on this site. I am HIV-negative and have just recently started to date a guy who is HIV-positive. I am 29 years old and have only ever slept with one person, who was also negative. So as you can imagine, this has been a really emotional journey for me. I have not had sex with my current HIV positive boyfriend yet. I am waiting till I am informed on all of the risks involved, before preceding. I have been doing a ton of research online, and keep getting conflicting results. I really love him, and want to try to make this work. I also want to feel comfortable having sex with him. My question I had was regarding oral sex. How safe is oral sex without a condom and without the guy ejaculating in your mouth? I am trying to keep an open mind, but I cannot imagine not being able to have unprotected oral sex with my boyfriend. Using a condom for everything else is fine by me. Please shed some light on this situation for me. I am just trying to make good choices and have the knowledge before we start having sex. Thank you so much for your time.

Response from Dr. Frascino

Hi,

The HIV risk associated with oral sex is definitely a QTND (question that never dies). What we can say is that overall risk of HIV acquisition/transmission via oral sex is very low. An insertive partner has less risk than a receptive partner. Review the information in the archives. We have entire chapters devoted to oral sex, magnetic couples, HIV-sexual transmission, etc. Also, I'll post below a summary of recent information presented at medical conferences discussing the latest information on the HIV transmission risk related to oral sex. Many magnetic couples have decided the risks associated with oral sex are acceptably low and forego using condoms. Others try to adhere to an absolutely no-avoidable-risk policy and hence cover their penis popsicles before all oral action. Ultimately only you and your partner can decide how much risk is acceptable. Some risk-adverse folks never drive above the posted speed limit even if there isn't another car in sight for miles and miles. Others never wear their seatbelt and text while speeding on the freeway during rush hour. We all make calculated decisions about acceptable risk everyday. You need to do the same thing with HIV and oral sex.

Dr. Bob

TRANSMISSION VIA ORAL SEX

The risk of HIV transmission through oral sex has been a subject of debate since the early years of the epidemic. But the issue is difficult to resolve based on epidemiological studies, since most people do not limit themselves to a single sexual practice. As described in the December 2008 issue of the International Journal of Epidemiology, researchers from Imperial College in London undertook a systematic review to assess the risk of HIV transmission via "orogenital intercourse," both fellatio (on a man) and cunnilingus (on a woman).

The authors searched the PubMed database and bibliographies of relevant articles through July 2007. Out of the 56,214 titles searched, they identified ten potentially appropriate studies. Two additional studies were identified through bibliographies, and one was found through discussions with experts. Ten studies, all from North America or Europe, provided estimates of HIV transmission probabilities per partner, incidence per partner, incidence per study participant, and incidence per sex act. Only three were conducted after the advent of HAART, which suppresses viral load and therefore reduces transmission risk. Given the small number of studies, they did not consider a meta-analysis (in which data from all studies are pooled) appropriate.

Six studies reported no instances of transmission via oral sex. The four studies that reported non-zero estimates included per-partner estimates of 20% (in a small study with only ten participants) and 1%, one per-study-participant estimate of 0.37%, and one per-act estimate of 0.04%. "There are currently insufficient data to estimate precisely the risk from orogenital intercourse exposure," the investigators concluded. "The low risk of transmission evident from identified studies means that more and larger studies would be required to provide sufficient evidence to derive more precise estimates."

Saliva from both exposed uninfected individuals and low-risk control subjects exhibited HIV-neutralizing activity. However, a significant difference was seen for immunoglobulin A1 (IgA1), with 13 of 25 exposed uninfected individualsbut none of the 22 presumably unexposed control subjectsexhibiting HIV neutralization. Based on these findings, the researchers concluded, "Unprotected oral sex evokes a salivary IgA1-mediated HIV-neutralizing response that persists over time during continuous exposure in uninfected male partners of infected men."

Life in Crisis (COMING OUT OF THE CLOSET, 2010) Mar 28, 2010

Hey Doc.

I have come here many times and read some of the posts that were posted by people who fear this disease. I'm like the other people who fear for HIV and I'm scared to death.

Here's why: I found a thrush on the side of my left cheek in my mouth, I panicked to death. That's why I see little white bumps of thrush on my lips.

In 2009, when I was smoking a lot during Super Bowl Sunday, my throat was discomforting. Not sure if it's oral thrush in throat.

Two years earlier, in 2007, I wasn't sure if it was leukoplakia on the side of my tongue but I'm not sure if it's confirmed or not.

To be honest, back in 2000 through 2002, I had oral sexual contact with men three times for a very short time, like five seconds and no longer. I'm not sure if it's premature ejaculation or not but I must've contact it through some sort of a cut that I wasn't aware of. It's true that the risk of contacting HIV through oral sex is very low, I may have hit that mark in some way and I'm scared to death.

I'm afraid of dying Doc. I'm like everyone else who's afraid of the disease that can kill you and I haven't got test yet.

The reason I'm afraid of being tested is because I don't want people to find out that I been hiding my sexuality from everyone and have someone to take me to get tested.

I don't want to die in a early age of 24.

I need help before it gets worse.

Response from Dr. Frascino

Hi,

I agree your life is in crisis, but the problem is not HIV. Rather, your problem is that you've "been hiding (your) sexuality from everyone . . . ." Denying or hiding your sexual orientation has resulted in irrational fears of being HIV infected. This may well be exaggerated by your guilt.

Oral sex carries only a very minimal risk for HIV transmission. From your description, you do not have thrush or oral hairy leukoplakia.

My advice is that you seek counseling (psychotherapy) to help you confront and conquer your irrational fears and also to help you come to terms with your sexual orientation.

Check out the archives for other coming out stories. I'll repost below a small sample of what can be found in the archives.

My advice is simple:

Be honest with yourself and others regarding your sexual orientation.

Stop smoking. If you don't, cigarettes will kill you in a very painful and undignified fashion.

If you remain worried about your extremely low HIV-acquisition risk, get an HIV-antibody test. Stop worrying about what others may think. Those who matter won't care and those who care don't matter! By the way, both gays and straights get HIV tested!

Get psychotherapy for your irrational fears and sexual orientation issues.

Good luck.

Dr. Bob

reply (COMING OUT OF THE CLOSET, 2009) Dec 29, 2009

in response to http://www.thebody.com/Forums/AIDS/SafeSex/Current/Q205859.html

Well thank you very much for responding to my query with detail and concern, I appreciate it.

I will report back on the three month mark with my results. I am wondering, though, if a sooner test would be reliable, at least to lessen my anxiety.

Bob, it's not guilt, its my area i live, the non-tolerance, the fuck-you-faggot attitude. I have been between Key West to San Fran and loved the people I was around. I, personally am cool with my bisexuality, but my wife uses the "thats gay" joke infinitely daily! My father is in a biker gang, and my mom's new hubby has this thing against the "gay community."

If I am honest, I will lose everyone. Will you be my faux-father?

I understand that keeping it real will do me such a goodness, but keeping it tucked away allows other okay facets of life continuance.

Maybe I can outlive everyone and be true then! I want to be me, but I cannot (at least thats how it looks from where I am.) But then I have the notion to die before everyone else and put my double-identity, my anxiety, my secrets to rest.

I know this goes way beyond your forum of safe-sex and HIV prevention, so I apologize for unloading unto you. It's just reallly fricken hard to deal with it when one has NO support whatsoever.

Im F'd if I do and F'd if I don't. But I must learn protection, protection, protection; talk to my GP, and contemplate...

I shall see you in two months, have a great new year

Response from Dr. Frascino

Hello,

Your story is quite similar to many I receive. The "I can't come out because my situation is so unique" story actually applies to almost every gay person in the universe, except for maybe a few flamers in the rightwing GOP (Larry Craig, Ted Haggard, Mark Foley) and loads of Catholic priests, because no matter what they say, let's face it, everyone knows they are gayer than the Xmas windows at Macy's!

You state if you are honest you'll lose everyone. That includes your "that's gay" joking wife, your biker gang dad and your stepdad who "has this thing against the gay community." Hmm. Now, tell me again why you would consider it a loss if these intolerant creeps no longer considered you one of the gang? It seems to me you can have two families: your "biological" family (sorry, you drew the short straw in this category) and your "logical" family (these would be the folks like the ones you loved to be around in Key West and San Francisco).

As for my being your "faux father," well, I've never played the "daddy" role before, but hell, perhaps being a silver fox would be hot!

OK, now back to you . . . . It seems you realize at least on some level that "keeping it real" would be beneficial for you, but you also state: "Keeping it tucked away allows other okay facets of life continuance." Hmm. Sorry, I don't buy that. Just reread some of your other comments as to how well your current secret life is working out for you: (1) "Maybe I can outlive everyone and be true then." Yeah, there's a brilliant plan that takes delayed gratification to new heights. (2) "I have a notion to die before everyone else and put my double-identity, my anxiety, my secrets to rest." Another brilliant idea! Dude, even if you commit hari-kari, you'll still be gay or bi or whatever and your homophobic scumbag relatives will still be homophobic scumbags. (3) "It's just really frickin' hard to deal with it when one has no support whatsoever." See what I mean about your current plan being unworkable. Your "keeping it tucked" will only lead to increasing anxiety.

Finally, I should answer your question. HIV-antibody tests taken prior to the three-month mark are not considered conclusive. Certainly any negative test would be considered encouraging and might lessen your anxiety, but do keep in mind the results would not be definitive if you test within the window period.

Good luck. The New Year is just around the corner. Hopefully one of your resolutions will be to fight back against the "non-tolerance and fuck-you-faggot attitudes," which currently surround you.

Dr. Bob

Can a Christmas donation get me a response? Dec 28, 2009

Dr. Frascino-

I recently submitted a few questions here without any response. But in reading, I see that donations to your foundation have a larger propensity for being answered. Since I gave a good amounted donation, I have a few!

1) I take it you don't answer every email that hits your inbox, but do you read everyone? If no, then bunk on you! If you do, and you decide not to respond, does that mean you see no concern for alarm?

2) If I were to have acute HIV, would there be anything to alleviate the signs/symptoms? I was taking a herbal/homeopathic remedy and I wonder if I just hid the symptoms of acute HIV. I had a sore throat for two and half weeks, nothing else (no fever, no rash, no gland swelling-although my glands seem harder than I have read they should). My GP RXd azithromyacin for 5 days and the throat went away, but is now coming back. Would homeopathic or antibacterial interventions mask acute HIV?

3) I see that all of my 'exposures' were on the minimal risk level, but if one is to fellate a couple men and a few TS's, would more than one add to higher chances of oral transmission? I also had rubbing/frottage (w/ 1 TS) and analingus (I rimmed 2 females), does that add up even more? [insertion INSERTION is always safe]

4) What do you say to a patient of yours addicted to sex? Lets say the patient used a portion of his money for a charitable donation and cannot afford at this time counseling and SA (sexaholics anonymous) isnt in his area; combined with the fact that he is a closeted bisexual who is scared to talk to anyone? You can just see judgment in others non-verbal cues, and he needs to hear something reassuring and comforting. I ned to hear that my attractions are okay (i understand that my behaviors might not be so okay though) and that I can get some kind of help for my unquenchable hunger for sexual proclivities.

5) Can I please have some good karma, PLEASE. Its Christmas and Im scared shitless that I will have a really bad day in February (3mos) and the anxiety is killing me. I know I need to change some or all of my behaviors, but can you help me to February 16th-ish.

Being forced to reveal my identity (sexuality) and HIV status could be an all-around save or a devastating blow. Depends how I look at it with the caveat of my marriage and three children.

I could be fucked and I need you to hear me; I have nowhere else to turn, man.

Response from Dr. Frascino

Hello,

1. I do indeed read all the questions that are submitted to this forum, but because there is only one of me and gazillions of "yous," I can only respond personally to a small percentage. Donations to The Robert James Frascino AIDS Foundation do not influence which questions are chosen for a personal response (other than perhaps comments I post thanking someone for their generosity and compassion). See below for a discussion as to why I do or do not respond to questions.

2. Herbal and/or homeopathic remedies do not cover up (or help in any way) symptoms of acute HIV. In fact, herbal/homeopathic remedies don't really do anything at all for any real disease process! (See below.)

Antibiotics, like azithromycin, treat bacterial infections and have no effect on viral infections/symptoms.

3. Each episode of sexual activity carries the same degree of risk. It's like flipping a coin. Each time you flip, you have a 50% chance of coming up with heads, even if the previous 20 flips were all heads as well! Frottage is not considered a risk for HIV transmission. There have been no documented cases of HIV transmission from rimming or getting rimmed (analingus).

4. First off, sexual orientation; be it gay, straight, bi-curious or closeted Mormon Republican; is not a choice (except for that last one in the list). Guilt related to one's sexual orientation is unhealthy. Closets, too are health hazards! As Glenda the Good Witch in the Wizard of Oz sings (and I recommend), ". . . come out, come out wherever you are . . . ." Your fears of "judgement" and "non-verbal cues," etc., are related to your internalized homophobia, guilt, and self-esteem issues. Dude, whether you are straight as a lawn dart or gay enough to bottom for Liberace, you are what you are and it's OK by me. As for those who would be judgmental (Republicans, religious wingnuts, etc.), you'll eventually realize when it comes to your sexual orientation, "those that matter won't care and those that care don't matter!"

I have no way of determining if you are a sex addict (I tend to doubt it) or merely a repressed horned-up dude. I'd suggest you discuss this concern with your general medical doctor. You should have no secrets from him. He will be able to evaluate your concerns and make an appropriate (and affordable) referral if it's needed.

I just got to the point in your post where you mention the wife and three kids. Take everything I mentioned above about guilt and multiply it exponentially to the nth degree.

It's not that you have nowhere to turn. Rather, you just need to start being honest with yourself and everyone else. Your way out of your misery is simple: merely tell the truth.

Good luck.

Dr. Bob

Response to Q205937.html, H.a.Q. (COMING OUT OF THE CLOSET, 2010) Feb 26, 2010

Doctor "Awesome Smile" Frascino-

I am happy to inform you that I am Here and I'm Queer! Yes, I had a lengthy conversation with my professor who was understanding and very accepting to my new identity as a gay/bi man (he said "you don't need to fully figure that out right now, just embrace who you are and enjoy what you will"). He did, however, allow me to plan a date to converse with my wife (he will be close nearby if needed), which I have yet to have the courage to do so. We are currently talking about my family's knowledge and the best way/when to do so.

I feel one-thousand percent better that I am real with myself and slowly am real with certain friends (told a few classmates, some straight, some gay) who were surprisingly accepting as well. By-and-large, I feel more secure in this group (past[Key West, San Fran] and current) because it feels like the acceptance and security are strong and long-lasting.

Thank you, though, for starting the snowball (wicked snowfall this year) of my release of anxiety, guilt, shame, and anger. When I told him my truth, I near passed out due to the total release of stress held within me. That alone is what I am banking on in helping me discuss this to my wife and family; the release of even more stress is exciting.

Robert Frascino, I love you for what you do for our community and how you have aided in my truthful experience. Thank you...

When I am in San Fran again, I will send you a question here asking where you like to get your favorite beverage, because I am buying you one or more.

Lastly, the impending doom of HIV status brought me here, but it wasnt the final motivator the real concern I held. Therefore, I believe my HIV status is not of concern for anyone. What is of concern is that I am healthy and happy and the fact that the advice you offer is helpful, thorough, and medically educated.

I will say it again- THANK YOU

with Love - Steve

Response from Dr. Frascino

Hi Steve,

Gosh, I just helped another closeted guy come out!?! No wonder the rightwing religious-wingnut Republicans hate me so much.

Congratulations Steve. You are already feeling the benefits of being honest with yourself and others. I should warn you, however, that coming out to your wife and family may not be quite as easy as being honest with your professor. Nonetheless, it's absolutely the right thin to do. Remember, honesty is never the wrong choice!

Good luck and welcome to our side of the proverbial fence!

Dr. Bob

Slowly coming out of the closet +donation for some words of advice Nov 17, 2009

Hi, I'm 17 and little by little I've been inching my way out of the closet. It's hard because I have a lot of guilt;my religion. And so, this guilt has turned into fear and the fear is HIV. My grandmother says that HIV is to punish gays. She's obviously VERY ignorant, but in some way it's suck with me.

The other day while shopping, I was looking at some clothes on a rack. While holding a shirt I noticed a few spots on it, that looked like blood. I was holding it with my hand that I had cut very severely the day before. If this was HIV infected blood, and because I rubbed my finger that was severely cut on it, would this be an HIV risk? I also touched my friends ear and face a few times and tapped his butt in a playful way. Now I'm worried about them.....

I will donate $40 (all I have at the moment) but promise to send all my other "in the closet" friends to this site for valuable information. Thanks for doing this. I appreciate people like you, whom I look up to.

Love, Scared and alone.

Response from Dr. Frascino

Hey there Closet-Guy,

I'm sure Granny means well, but when it comes to compassion, science or even common sense concerning HIV and being gay, she is obviously suffering from cranio-rectal-inversion. (That means she has her head up her butt.) As for organized religion and the gay issue, they don't even mean well!

Your HIV risk from the possibly blood-spotted shirt is completely nonexistent. HIV doesn't survive very long at all outside the body. Likewise, there is no risk from touching your buddy's face, ear and butt with your day-old cut hand.

As for coming out, it's never easy, but it's always the right thing to do. Do not allow either God or Granny to keep you locked in the closet! Closets are health hazards!

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